The eyes play a major role in facial expression, charisma and beauty.
Aging eyes can wrongly give the image of someone who is tired or sad. However, there is a veritable therapeutic arsenal available to the surgeon thanks to the new techniques of aesthetic medicine but also to plastic surgery proven.
The eyebrow is an anatomical element that plays an aesthetic and social role. It characterizes and personalizes the gaze, and is a vector of communication. It's difficult to draw up an "ideal standard", as morphological heterogeneity varies widely from one individual to another and from one culture to another.
Nevertheless, a classic scheme distinguishes :
- The head of the eyebrow starts from an imaginary line that passes through the wing of the nose and the inner canthus of the eye (inner corner of the eye).
- The arch of the eyebrow (the highest point of the eyebrow) lies on an imaginary line that begins at the wing of the nose and passes through the center of the upper eyelid.
- The tail of the eyebrow lies on an imaginary line starting at the wing of the nose and passing through the outer canthus of the eye (outer corner of the eye), and should be slightly higher than the head.
Anatomically, the eyebrow is an arched musculocutaneous protrusion with hairs that separates the forehead from the upper eyelid. Eyebrows serve to protect the eyes from the sun and, in general, from external aggressions such as dust or sand: indeed, human beings will automatically frown to avoid injuring their eyes.
Eyebrow shape and position play a very important role in eye expression. Depending on its shape and mobility, it can express fatigue, surprise, anger or sadness.
Depending on fashion and culture, the eyebrow may be plucked, tattooed or decorated... a veritable object of seduction for women.
The eyebrow changes with age: the skin, surrounding muscles and Charpy's fat pad all age together, altering the position and shape of the eyes.
As the years go by, the eyebrow gets moth-eaten, and hairs don't grow back as well where they've been plucked too much, but also at the very heart of the eyebrow.
On the glabella, vertical wrinkles (lion's wrinkles), often two in number, mark the break caused by repeated contractions of the corrugator.
At the root of the nose, horizontal wrinkles mark the action of the procerus.
At the temporal level, radial wrinkles, perpendicular to the orbicularis muscle fibers of the eyelids, form crow's feet wrinkles. Laterally, the temporal depression is accentuated by the loss of temporal muscle and fat.
This drooping of the eyebrow, combined with ptosis of the upper eyelid, progressively limits the field of vision, leading to accentuated reactionary contraction of the forehead muscle, particularly on the side of the directing eye, with asymmetrical eyebrow height and forehead wrinkles.
Botulinum toxin and hyaluronic acid injections make rejuvenation possible
To maintain the eyebrow's position, injections of botulinum toxin into the forehead muscle must respect the lower third of the forehead muscle, so that the muscle retains its function as an eyebrow elevator.
Asymmetries in eyebrow position are common. It is therefore necessary to independently analyze the frontal muscle balance of each eyebrow.
Eyebrows are most often controlled by a person to express feelings such as anger, confusion, astonishment or disdain. Some people are endowed with eyebrow independence.
They can move their eyebrows separately, enabling them to express a wider range of emotions: frowning indicates displeasure, raising the eyebrows indicates surprise, and so on.
The action of botulinum toxin can modify negative expressions, resulting in a beneficial effect on the patient's air (fit, serene, rested) and improving both mood....
As we age, the fat under the eyebrow diminishes, causing it to droop.
Hyaluronic acid injections add volume and lift the eyebrows.
Regalvanizing the eyebrow body with hyaluronic acid gives a dynamic, vigorous effect. A single session per year is usually sufficient.
On the surgical side, a facelift is a cosmetic surgery procedure that tautens the skin of the face. Also known as a "mannequin" facelift, it focuses exclusively on the upper part of the face.
The purpose of the temporal lift is to slightly raise the end of the eyebrows and slightly reduce the "crow's feet" wrinkles. Popular with young women, this cosmetic surgery procedure corrects sagging skin in the upper part of the face, tightening it, erasing wrinkles and enlarging the eyes. When performed alone, the mini facelift is of limited benefit. This is why the temporal lift is often combined with other techniques.
Treatment of drooping eyebrows
The eyebrow is subject to permanent contraction of the orbicularis oculi muscle, which causes the tail of the eyebrow to droop, resulting in a sad look. The aim of eyebrow treatment is to maintain or raise the tail of the eyebrow, so that the eyes remain alert and clear. The botulinum toxin "botox can be injected into the orbicularis oculi muscle to rebalance tensile forces at eyebrow level and up the tail of the eyebrow.
A drooping eyebrow can be treated in different ways.
Botulinum toxin injections:
A toxin injection on the outer part of the orbicularis oculi muscle raises the tail of the eyebrow. Botulinum toxin prevents the orbicularis oculi muscle from contracting, resulting in the eyebrow tail rising.
Injection of hyaluronic acid:
It is possible to injecthyaluronic acid on the outer side of the eyebrow to restore a harmonious curve. This procedure fills a loss of volume on the lower outer side of the eyebrow and lifts the outer part.
Heavy eyelids
In the case of significant skin excess, compensatory contraction of the frontalis muscle to keep the eye open can cause horizontal forehead wrinkles. This excess eyelid skin can be removed with the blepharoplasty.
Bags under the eyes
The lower eyelid may be hollowed or show sagging skin and excess fat.
Dark circles
If they are too pronounced, they give the appearance of tiredness and indicate the onset of aging.
Crow's feet wrinkles
Crow's feet wrinkles can appear due to overactivity of the orbicularis oculi muscle. Botulinum toxin ("botox") can be injected to reduce muscle contractions and thus diminish crow's feet wrinkles.
There's a whole arsenal of treatments available to improve, rejuvenate and beautify the eyes, whether through aesthetic medicine or cosmetic surgery.
Eye rejuvenation
Before/After
Treatment of under-eye bags
Puffiness under the eyes is caused by fatty hernias due to sagging tissue and enlarged orbital fat.
In minor forms :
A fat injection can mask fatty hernias.
In moderate to severe forms :
A lower blepharoplasty can be performed to correct excess fat and skin.
Pathophysiology of aging of the lower eyelid :
In the lower eyelid, the pathophysiology is complex, and the role of adipose tissue is again important. Retro-septal intra-orbital fat protrudes through the septum, and is responsible for the appearance of lipoptosis.
The three components of this protusion are distension of Lockwood's ligament, fragility of the orbital septum and atrophy of the orbicularis muscle.
Lockwood's suspensory ligament plays a predominant role. This thickening of the orbital capsulopalpebral fascia arises from the union of the aponeuroses of the inferior oblique and inferior rectus muscles. It inserts onto the internal and external canthal ligaments, the tarsus, the orbicularis muscle and the skin tissue, and is one of the orbit's major suspension devices. As we age, the external canthal ligament, which is partly muscular in nature, slackens, causing the Lockwood ligament to elongate, pressing the globe it supports against the underlying intraorbital fat.
The result is a reduction in intra-orbital fat volume, leading to senile enophthalmos, which is all the more marked because of the ptosis of the eyebrow fat body.
Atrophy of the orbicularis muscle too, as it loses its pre-tarsal and pre-septal palpebral support role, contributing to the ptosis of the elements at this level.
The virtual pre-septal space appears, inside which the septum and retro-septal fat ptosis. A septo-musculo-cutaneous bulge with adipose content is formed: the inferior palpebral pouch.
More recently, repositioning has been achieved by septal plication or structural reinforcement during palpebro-malar supsension or sub-periosteal malar lifts. These techniques can be combined, but only a pre- and per-operative analysis can determine which procedures will be the most effective.
Aesthetic eyelid surgery
Heavy eyelids correspond either to dermatochalasis "excess skin on the upper eyelid" or blepharochalasis "overall sagging of the eyelid".
The treatment for heavy eyelids is the blepharoplasty:
A personalized assessment will enable the surgeon to perform surgery adapted to each individual case, depending on excess skin, the presence or absence of a fatty hernia, the drooping of the eyebrow tail...
In the case of minor forms, botulinum toxin injections can be used for medical treatment.
In most cases, ptosis is the predominant aging mechanism in the upper eyelid. It affects the pre and retro septal elements.
At the pre-septal level, Charpy's adipose body contributes to eyebrow ptosis.
As the septum weakens, the intra-orbital structures become visible, and the superior retroseptal fat herniates. This is predominantly medial, but may also involve preaponeurotic fat more medially.
The upper eyelid thus appears fuller, the tail of the eyebrow more or less ptosed, and the dermatochalasis more or less pronounced. The contribution of these different fat compartments to ageing must be analysed preoperatively.
Pressure on the orbit increases the protrusion of intra-orbital fat and has no effect on pre-septal fat.
More rarely, the upper eyelid evolves in a skeletal mode. In this case, atrophy predominates over ptosis. It involves all fatty compartments, both intra- and extraorbital. The tissue covering the orbital rim becomes thinner.
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